CPT 81447 Reimbursement & Benchmarks

CPT 81447 denotes a targeted genomic sequencing panel for solid organ neoplasms that analyzes DNA across 5–50 genes. This molecular pathology service supports identification of actionable somatic mutations and other genomic alterations that can influence diagnosis, prognosis, and treatment selection in oncology. The code matters nationally as precision oncology testing becomes routinely integrated into cancer care pathways and as payers refine coverage and billing policies for multigene panels.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. Readers will find a concise overview of coding context, payer coverage landscape, common billing modifiers, associated clinical diagnoses, and related pathology codes used alongside targeted genomic panels. The publication also summarizes clinical scenarios where a 5–50 gene DNA panel is commonly applied and highlights relevant adjacent pathology procedures that may be billed in the laboratory workflow.

The content is designed to inform laboratory billing staff, coding specialists, and policy analysts about the clinical purpose of the code, typical service setting, and the payer mix most relevant to reimbursement and documentation considerations. Data not available in the input is noted explicitly where applicable.

CPT Code Overview

CPT 81447 is a targeted genomic sequence analysis panel for solid organ neoplasms, performing DNA analysis of 5–50 genes. The test identifies clinically relevant somatic variants within a focused set of genes commonly implicated in solid tumor pathology, supporting diagnostic, prognostic, and therapeutic decision contexts.

Service Type: Pathology and Laboratory

Typical Site of Service: Laboratory (POS 81)

Clinical Context

A patient with a confirmed or suspected solid organ malignancy undergoes tumor molecular testing to guide targeted therapy, prognosis, or clinical trial eligibility. Typical specimens include formalin-fixed, paraffin-embedded tumor tissue from surgical resection, core needle biopsy, or fine needle aspiration cell block. The specimen is sent to a molecular pathology laboratory (POS 81) where a pathologist or molecular technologist performs a targeted genomic sequence analysis panel of tumor DNA covering 5–50 genes (81447). The laboratory completes technical processing, sequencing, and variant calling, and the pathologist performs interpretation and issues a clinical report describing detected somatic mutations and their potential therapeutic or prognostic implications. Common clinical contexts include staging and treatment planning for lung (C34.90), breast (C50.919), colon (C18.9), prostate (C61), or pancreatic (C25.9) cancers.

Coding Specifications

Modifiers
26 — Professional Component: Use when billing only the professional component (interpretation and report) performed by a qualified pathologist or molecular geneticist.
TC — Technical Component: Use when billing only the technical component (laboratory processing, sequencing, instrumentation, and raw data generation) provided by the performing laboratory or facility.

Blue Cross Blue Shield and BUCA share the same national mean rate for 81447, at $80.02, while Medicare values are not present in the input. Comparing Medicare to BUCA (average commercial), the input does not include Medicare mean values, so a direct numeric comparison cannot be made.

Dispersion across reported payers is minimal where data exists: for both Blue Cross Blue Shield and BUCA the 25th, 50th, and 75th percentiles are $80.00, $80.00, and $80.00 respectively, yielding a P75–P25 range of $0.00, which indicates a very tight distribution for those payers. Payers without provided values are listed as "Data not available in the input." The table and chart below present the full breakdown.

Related Diagnoses

C34.90 — Malignant neoplasm of unspecified part of unspecified bronchus or lung

Relevance: Lung cancers commonly undergo targeted genomic panels to identify actionable somatic mutations for targeted therapies, making 81447 clinically relevant for diagnostic and therapeutic planning.
C50.919 — Malignant neoplasm of unspecified site of unspecified female breast

Relevance: Breast carcinomas are frequently evaluated with molecular panels for mutation profiling and to guide systemic therapy selection and clinical trial eligibility.
C18.9 — Malignant neoplasm of colon, unspecified

Relevance: Colorectal cancers are assessed with genomic testing for mutations and markers that inform targeted therapy and prognosis; a targeted DNA panel 81447 may be ordered for such cases.
C61 — Malignant neoplasm of prostate

Relevance: Prostate cancers may be evaluated with targeted genomic panels to identify actionable alterations or to inform advanced disease management strategies.
C25.9 — Malignant neoplasm of pancreas, unspecified

Relevance: Pancreatic adenocarcinomas can be tested with tumor genomic panels to detect mutations that influence therapy selection and eligibility for precision medicine trials.

Related CPT Codes

81445 — Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes: A closely related code with an identical descriptor; may be an alternate code in some billing scenarios. Clinically, it represents the same category of targeted tumor DNA panels and can be used as an alternative depending on payer policy.
81455 — Targeted genomic sequence analysis panel, hematolymphoid neoplasm, DNA analysis, 5-50 genes: Represents targeted panels for hematolymphoid malignancies rather than solid organ neoplasms. Used in workflows for blood or marrow-derived cancers and is an alternative code when the specimen and clinical indication are hematolymphoid.
88342 — Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure: Performed on tissue specimens to assess protein expression (e.g., hormone receptors, HER2, PD-L1) that complements molecular DNA testing. Often performed on the same specimen prior to or concurrent with molecular studies.
88341 — Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure: Billed for additional antibody stains beyond the initial 88342. These IHC stains can be part of the pathology workflow that precedes or accompanies molecular panel ordering.
Common joint use: 88342/88341 are commonly used together with 81447 when both immunohistochemical and targeted genomic analyses are performed on the same tumor specimen. 81455 is an alternative code used when the disease process is hematolymphoid rather than a solid organ.

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Summary & Overview

CPT 81447: Targeted Genomic Sequence Panel for Solid Organ Neoplasms